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122 Cards in this Set
- Front
- Back
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Masticator Space Lesions DDx – Most common |
Odontogenic abcess
Sarcoma NHL SCC from oropharyn(retromolar trigone) Rhadomyosarcoma in pediatric population Accessory parotid gland Benign Masseteric Hypertrophy |
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Masticator Space Lesions DDX – by category
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Pseudotomor
Accessory parotid gland Benign Masseteric hypertrop V3 denervation atrophy Congenital Hemangioma Lymphangioma Inflammatory Odontogenic abscess Mandibular osteomyelitis Benign tumor Osteoblastoma leiomyoma Neural sheath tumor Malignant Tumor Sarcoma soft tissue chondrosarcoma osteosarcoma Malignant schwannoma NHL SCC from retromolar trigone of oropharynx Mandibular mets Rhabdomyosarcoma in peds |
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What is a complication of MS infection?
In which direction does infection spread? |
Skull base osteomyelitis (destruction of pterygoid wing)
Upward via least resistance |
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What makes malignant tumor from MS unresectable?
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Invasion of skull base
Check for suprazygomatic MS spread to adjust radiation ports!! |
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Which way is the PPF (prestyloid paraphyngeal fat) displaced in Masticator space lesions?
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1. Posteriomedially
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If tumor in MS, what cranial nerve should be inspected for perineural spread? What is the route?
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1. V3
2. 2. via foramen ovale (medial pterygoid fascia inserts medial to FO) |
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Which motor nerve supplies muscles of mastication?
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1. Masticator nerve (motor branch) of V3
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What are the masticator muscles?
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1. Masseter
2. Medial pterygoid 3. Lateral pterygoid 4. Temporalis |
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What are the two nerves that enter the masticator space?
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1. Masticator nerve (to all masticator muscles)
2. Inferior alveolar nerve |
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What are the routes of infection/malignancy into the skull base?
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1. Muscle attachments to skull base (infection goes up b/c firm attachment of periosteum to inferior mandible
2. V3 through foramen ovale à Meckel’s cave à root entry zone in lateral pons |
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What 3 clinical features suggest involvement of V3 by tumor?
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1. Atrophy of masseter
2. Mandibular pain 3. Serous otitis media (due to tensor palatini dysfunction due to V3 branch involvement causig Eustachian tube malfunction) |
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What is the temporal fossa?
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1. The suprazygomatic MS
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What is the infratemporal fossa? Aka?
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1. Between PPF and zygomatic arch at level of nasopharynx
2. Nasopharyngeal MS |
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What borders the MS?
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1. Posteromedially = masticator space
2. Anteriorly – buccal space 3. Posteriorly – parotid space 4. What is in the buccal space? 5. Buccinator muscle 6. Parotid duct 7. Facial artery and vein 8. Buccal fat pad |
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What is a pitfall in perineural spread imaging for V3?
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Not imaging along its entire course i.e.
Inferior alveolar nerve and masticator nerve 3. Mandibular foramen 4. Foramen ovale 5. Meckel’s cave root entry zone along lateral pons |
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What is the significance of MS infection involving mandible (osteomyelitis)? Tumor?
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1. Longer antibiotics
2. More likely perineural spread along IAN or V3 main trunk |
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Why is CT the initial study of choice in evaluating patients with suspected infection of MS?
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1. Identify duct stone
2. R/o mandibular osteomyelitis |
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Name 3 pseudomasses of MS?
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1. Accessory parotid gland
2. Benign masseteric hypertrophy 3. Cranial nerve V3 motor atrophy |
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Benign Masseteric hypertrophy – most common cause, pitfall, most characteristic appearance? Imaging recc if not pathognomonic?
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1. Bruxism (molar grinding)
2. Unilateral mass with infiltrating margins – tumor/infection! 3. Well defined bilateral hypertrophy or if accompanied by pterygoid/temporalis hypertrophy and atrophy with hx of bruxism 4. Close radiologic f/u to r/o tumor |
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What muscles does the motor root of V3 innervate?
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1. Masticator muscles
2. Anterior belly of digastric 3. Mylohyoid muscle 4. Tensor veli palatini, tensor tympani |
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What are imaging signs of V3 denervation atrophy? How long after injury?
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1. Fatty infiltration
2. Volume reduction 3. 6 weeks |
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What is initial symptom in odontogenic Abscess?
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Trismus
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Odontogenic abscess with “lumpy jaw” – what should you think?
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Actinomycosis
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Sarcoma – where does chondrosarcoma arise from? Osteosarcoma?
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1. Chondrosarcoma – from TMJ
2. Any along mandible |
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Tubular Mass in the MS?
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1. Malignant schwannoma along IAN, V3
2. Perineural spread |
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What secondary feature of MS mass suggests NHL?
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Other cervical nodes, extranodal lymphatic disease (i.e. waldeyer’s ring)
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What is most typical for SCC of MS?
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1. Prior hx of treatment of oral cavity or oropharyngeal SCC
2. Look for perineural spread by IAN |
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RETRO-OCULAR MASS (Intraconal)
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. Hemangioma - - enhance - phleboliths seen in 10%
2. Optic nerve glioma 3. Optic nerve meningioma 4. Angioma 5. Lymphangioma 6. AVM |
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Extraconal-intraorbital Lesion – DDx
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1. Benign Tumor
a. 1. Dermoid Cyst b. Teratoma c. Capillary Hemangioma d. Lymphangioma e. Plexiform neurofibroma f. Inflammatory orbital pseuydotumor g. Histiocytosis X (usually arises from bone) 2. Malignant Tumor h. Lymphoma/Leukemia i. Metastasis j. Rhabdomyosarcoma |
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Extraconal-extraorbital Lesion – DDx
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1. FROM SINUS
a. Tumor – SCC, adenoCa, adenoid cystic, lymphoma b. Paranasal Sinusitis – most common cause of orbital infection (ethmoid in children, frontal in adolesc), mucormycosis in diabetics (destroys bone) c. Mucocele 2. FROM SKIN d. Orbital Cellulitis 3. FROM LACRIMAL GLAND – “MOLD” e. Metastasis f. Others (rhabdomyosarc, lymphangioma, sinus lesion) g. Lymphoma, lacrimal gland tumor h. Dermoid |
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Lacrimal Gland Lesion (superolateral orbit) – DDX
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MOLD
1. Mets 2. Others 3. Lymphoma, lacrimal gland tumor 4. Dermoid |
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Orbital Mass in Childhood – DDX in desc order
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1. Dermoid cyst – 46%
2. Inflammatory lesion – 16% 3. Dermolipoma – 7% 4. Capillary hemangioma <5% 5. Rhabdomyosarcoma 6. Leukemia/lymphoma 7. ON Glioma 8. Lymhangioma 9. Cavernous Hemangioma |
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Primary Malignant Orbital Tumors – DDx in desc order
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1. Retinoblastoma – 86%
2. Rhabdomyosarcoma – 8.1% 3. Uveal Melanoma 4. Sarcoma |
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Secondary Malignant Orbital Tumors – DDx in desc order
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1. Leukemia
2. Sarcoma 3. Hodgkins Lymphoma 4. Neuroblastoma 5. Wilms 6. NHL 7. Histiocytosis 8. Medulloblastoma |
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Orbital Vascular Tumors – DDx
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1. Orbital Varix
2. Hemangioma (capillary/cavernous) 3. AVM 4. CC fistula 5. Blood Cyst 6. Arterial malformation 7. Glomus Tumor 8. Hemangiopericytoma |
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Orbital Masses – DDx
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LO VISHON
1. Lymphoma/leukemia 2. Optic Nerve Glioma 3. Vascular Malformation: hemangioma, lymphangioma 4. Inflammation 5. Sarcoma: rhabdomyosarcoma 6. Histiocytosis 7. Orbital Pseudotumor, Osteoma 8. Neuroblastoma |
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Superolateral Quadrant of Orbit Masses – DDx
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1. Lacrimal Gland Tumor
2. Dermoid Cyst 3. Leukemic infiltration/Lymphoma 4. Pseudotumor 5. Hemangioma 6. Abscess 7. Mets (breast, prostate, lung) 8. Sarcoid 9. Frontal Sinus Mucocele 10. Wegener’s granulomatosis |
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Extraocular Muscle Enlargement – DDx
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1. Endocrine
a. Graves Dz b. Acromegaly 2. Inflammation c. Myositis – single muscle in adult, multiple muscles in children, positive response to steroids d. Orbital Cellulitis e. Sjogres disease, Wegener’s granulomatosis, lethal midline granuloma, SLE f. Sarcoidosis g. Foreign-body reaction |
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Extraocular Muscle Enlargement – DDx
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3. Tumor
h. Pseudotumor i. Rhabdomyosarcoma j. Mets, lymphoma, leukemia 4. Vascular k. Spontaneous/traumatic hematoma l. AVM m. CC fistula |
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Ocular Lesion Calcifications? – DDX
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NMR CT
1. Neurofibromatosis 2. Melanoma 3. Retibnoblastoma 4. Choroidal Osteoma 5. Tuberous Sclerosis |
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Intraocular Calfications – DDx
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1. RB - >50%
2. Astrocytic hamartoma 3. Choroidal Osteoma – young woman, very dense curvilinear mass aligned with choroidal margin of globe 4. Optic Drusen 5. Scleral Calcifications – systemic hypercalcemic states (HPT, hypervitaminosis D, sarcoidosis, chronic renal disease) OR elderly 6. Retrolental fibroplasia 7. Phthisis bulbi – trauma or infection sequela |
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Noncalcified Ocular Process – DDx
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1. Uveal Melanoma
2. Metastasis – 86% of ocular lesions in globe, usually in vascular choroid (breast, lung, Gi, GU, cutanesous melanoma, neuroblastoma), bilateral 30% 3. Choroidal Hemangioma – most common benign tumor in adults 4. Vitreous Lymphoma – diffuse ill-defined soft tissue density 5. Developmental anomalies a. Primary glaucoma b. Coloboma c. Staphyloma |
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Microphthalmia – DDx
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1. Bilateral with cataract
a. Congenital rubella b. Persistent hyperplastic vitreous c. Retinopathy of prematurity d. Retinal folds e. Loewe syndrome (Small globe and small orbit) 2. Unilateral f. Trauma/surgery/rTX g. Inflammation with disorganization of eye (pthisis bulbi |
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Dense Vitreous in Pediatric Age Group
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1. Retinoblastoma
2. Persistent hyperplastic primary vitreous (PHPV) 3. coats Diseas 4. Norrie Disease 5. Retrolental fibroplasia 6. Sclerosing endophthalmitis |
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Leukokoria in normal-sized eye – DDX
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1. Calcified Mass
a. Retinoblastoma b. Retinal astrocytoma 2. Noncalcified mass c. Toxocaral endophthalmitis d. Coats disease |
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Leukokoria with microphthalmia – DDx
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1. Unilateral
a. Persistent Hyperplastic Primary Vitreous (PHPV) 2. Bilateral b. Retinopathy of Prematurity c. Bilateral PHPV |
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Optic Nerve Enlargement – DDx
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1. Tumor
a. ON Glioma b. Optic Nerve Sheath Meningioma c. Infiltration by Lymphoma/Leukemia 2. Fluid d. Perineural hematoma e. Papilledema of intracranial hypertension f. Patulous subarachnoid space 3. Inflammation g. Optic Neuritis h. Sarcoidosis |
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Optic Nerve enlargement with fusiform thickening with central lucency = ___?
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Meningioma
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Optic Nerve enlargement with fusiform thickening without central lucency = ___?
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Optic Nerve Glioma
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Eccentric thickening (single or multiple nodules) -
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tumor
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Tubular ON enlargement
1. with central lucency 2. without central lucency |
1. subarachnoid process: mets, perineuritis, menignioma, perineural hemorrhage)
2. papilledema, leukemia, lymphoma, sarcoid, ON glioma |
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Lacrimal Gland Lesion
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1. Inflammation
a. Dacryoadenitis b. Mikulicz syndomre – nonspecific enlargment of lacrimal and salivarty glands a/w sarcoid, lymphoma, leukemia c. Sjogren syndrome – lymphocytic infiltration of lacrimal/salivary glands, with decreased lacrimation, xerostomia. A/w RA, SLE, scleroderma, polymyositis d. Sarcoidosis 2. Benign Tumor e. Granuloma, cyst, pleiomorphic adenoma/benign mixed tumor 3. Malignant Tumor f. Malignant mixed tumor (pleimorphic adenoca), adenoid cystic Ca, lymphoma, mets (rare) |
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Lacrimal Gland Enlargement
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MELD
1. Mets 2. Epithelial Tumor 3. Lymphoid Tumor 4. Dermoid |
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Bilateral Lacrimal Gland Masses
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LACS
1. Lymphoma 2. AND 3. Collagen-vascular disease 4. Sarcoidosis |
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Opthalmoplegia – DDX
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1. Lesions of CN III
2. IV 3. VI |
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Anopia
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1. Monocular blindess – ON lesion in fx of optic canal, amaurosis fugax
2. Bilateral heteronomyous defects – bitemporal hemianopa (chiasmatic lesion) 3. Bilateral homonymous defects – CVA, Brain tumor a. Homonymous hemianopia b. Quandrantinopia c. Central heianoptic scotomoa |
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Macropthalmia – DDx
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1. Without intraocular Mass
a. Generalized enlargment i. Axial myopia ii. Buphthalmos iii. Connective tissue disorder: Marfans syndromek, ehler-danlos, weill-Marchesani, homocystinuria b. Focal enlargement i. Staphyloma 2. With intraocular Mass c. With Calcifications i. Retinoblastoma d. Without calcifications i. Melanoma ii. Mets |
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Mandibular Hypoplasia syndromes – DDx
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1. Pierre-Robin syndrome
2. Treacher-Collins syndrome 3. Chromosomal abnormalities 4. pyknodysostosis |
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TMJ Destruction
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HIRT
1. Hyperparathyroidism 2. Infection 3. Rheumatoid arthritis 4. Trauma |
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Tooth Masses – Major Categories (2) + DDx
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1. Cystic Lesions
a. Radicular (periapical) Cyst - #1, non-vital tooth b. Ameloblastoma (adamantinoma of jaw) – most at angle of mandible, uni/multiloculated lytic, scalloped expansion, more aggressive local recurrence after exicision, 4-5th decade) c. Primordial cyst (dentigerous cyst around absent tooth) d. Giant cell reparative granuloma (nonodontogenic, lucent smooth multiloculated lesion) e. Traumatic bone cyst – associated with vital tooth, sharply marginated lucent lesion with fingerlike projections b/w roots f. Dentigerous Cyst – around erupted tooth, maxilla, posterior mandible, cystic expansile lesion containing tooth, may rarely degenerate into ameloblastoma |
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Tooth Masses – Major Categories (2) + DDx
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Sclerotic Lesions
g. Cementinoma – (periapical cemental dysplasia, women, 30-40, anterior mandible, at apex of vital tooth, often multicentric h. True cementoma – benign cementoblastoma i. Gigantiform cementoma j. Hypercementosis – bulbous enlargment of root, idiopathic pagets k. Benign fibro-osseous Lesions i. Ossifying fibroma – young adults ii. Monostotic fibrous dysplasia iii. Condensing osteitis l. Paget Dz – involves jaw 20%, bilateral symmetric involvement, loosening of teeth, hypercementosis m. Torus mandibularis (exostosis |
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Wide Skull Sutures – DDx
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1. Normal Variant
2. Congenital underossification – OI, hypophosphatasia, rickets, hypothyroidism, pyknodysostosis, cleidocranial dysplasia 3. Metabolic disease – hypoparathyroidism, lead intoxiciation, hpo/hypervitaminosis A 4. Raised ICP a. Intracerebral tumor, subdural hematoma, hydrocephalus (< 10 yo) b. Coronal ? sagittal 5. Infiltration of Sutures c. Meningeal mets from neuroblastoma, leukemia, lymphoma d. Poorly defined margings 6. Recovery e. Deprivational dwarfism, chronic illness, prematurity, hypothyroidism |
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Craniosynostosis Causes – DDx
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1. Primary craniosynostosis
2. Secondary craniosynostosis a. Hematologic – SCD, thalassemia b. metabolic – rickets, hypercalcemia, hyperthyroidism, hypervitaminosis D c. bone dysplasia: hypophosphatasia, achondroplasia, metasphyseal dysplasia, Down syndrome, huerler disease, skull hyperostosis, rubinstein-Taybi syndrome d. syndromes: Crouzon, Apert, Carpenter, Treacher-Collins, cloverleaf skull, craniotelencephalic dysplasia, arrhinencephaly e. microcephaly: brain atrophy/dysgenesis f. after shunting procedures |
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Craniosynostosis Types – DDx
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1. Scaphocephaly (dolichocephaly) – 55%, premature closure of sagittal suture – long AP
2. Brachycephaly (turricephalyu) – 10%, coronal/lambdoid, short AP, tall 3. Plagiocephaly – 7% - unilateral early fusion of coronal and labdoidal = lopsided 4. Trigonocephaly – metopic suture – forward pointing skull 5. Oxycephaly – coronal, sagittal, lambdoid 6. Cloverleaf skull – Kleebattschadel – intrauterine closure of sag, coronal, lambdoid |
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Wormian Bones
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PORK CHOPS I
1. Pyknodysostosis 2. OI 3. Rickets in healing phase 4. Kinky Hair syndrome 5. Cleidocranial dysostosis 6. Hypothyroidism/hypophosphatasia 7. Otopalatodigital syndrome 8. Primary acroosteolysis (hadju-cheney)/pachydermoperiostosis/progeria 9. Syndrome of Down 10. Idiopathic Normal up to 6 months!!! (most common) |
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Increased Skull Thickness
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HIPFAM
1. Hyperostosis Frontalis Interna 2. Idiopathic 3. Paget disease 4. FD 5. anemia 6. Mets |
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Button Sequestrum
1. Definition 2. DDx |
1. radiodense focus in middle of rounded lytic focus
2. TORE ME a. Tb b. Osteomyelitis c. Radiation d. EG e. Mets f. Epidermoid |
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Absent Greater Sphenoid Wing
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M FOR MARINE
1. Meningioma 2. Fibrous Dysplasia 3. Optic Glioma 4. Relapsing Hematoma 5. Metastasis 6. Aneurysm 7. retinoblastoma 8. Idiopathic 9. NF 10. EG |
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Widened superior Orbital Fissure
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A FAN
1. Aneurysm (ICA) 2. Fistula (CCF) 3. Adenoma (pituitary) 4. Neurofibroma |
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Central Skull Base Tumors/Lesions
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1. Developmental
a. Encephalocele 2. Infection/Inflammation b. Extension from paranasal sinus/mastoid infection c. Fungal disease (mucor in diabetics, aspergillosis in immunocompromised) d. Sinus + nasopharyngeal sarcoidosis e. Radiation Necrosis |
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Central Skull Base Tumors/Lesions
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3. Benign Tumor
f. Juvenile Angiofibroma g. Meningioma h. Chordoma i. Pituitary Tumor j. Paget Dz k. Fibrous dysplasia l. Glomus Tumor 4. Malignant m. Mets: prostate, lung, breast n. Chondrosarcoma o. Nasopharyngeal p. Rhabdomyosarcoma q. Perineural tumor spread: head and neck neoplasm |
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Basilar Invagination
1. definition 2. Causes 3. associations |
primary developmental anomaly of abnormally high position of vertebral colum prolapsing into skull base
2. Causes a. Condylus tertius – ossicle at distal end of clivus forming pseudojoint with dens/ant C1 arch b. Condylar hypoplasia c. Basiocciput hypoplasia (shortening of clivus) d. Atlanto-occipital assimilation – complete/partial failure of segmentation /w skull and C1 3. Chiari malformation 4. syndrohydromyelia in 25-35 |
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Basilar Impression
1. Definition 2. Causes |
1. aquierd form of basilar invagination (cranial settling) with bulging of cspine/foramen magnum into cranial cavity
2. PF ROACH a. Paget Disease b. Fibrous dysplasia c. Rickets d. OI, Osteomalacia e. Achondroplasia f. Cleiodocranial dysplasia g. Hyperparathyroidism, Hurler syndrome 3. Also skull base infection, RA |
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Temporal Bone Fractures
1. Longitudinal 2. Transverse a. Injury site b. Hearing loss type c. Middle ear involvement d. Ossicular dislocation e. Labyrinth involvement |
1. Longitudinal
a. Temporoparietal bone b. Conductive c. Injured d. Common e. Spared 2. Transverse f. Occipital g. Sensorineural h. Spared i. Rare j. Injured |
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Vascular Intratympanic Mass
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Glomus tympanicum
2. Aberrant ICA 3. Carotid artery aneurysm 4. Persistent stapedial artery 5. exposed jugular bulb 6. exposed carotid artery (ecstatic/tortuous) 7. hemangioma 8. Extensive glomus jugulare |
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Absence/Stenosis of EAC - DDx
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Congenital
a. Stenosis of the EAC b. Bony or membranous atresia of EAC c. Treacher-Collins syndomre d. Crouzon’s disease e. Klippel-Feil syndrome f. Goldenhar’s dyndrome g. Cleidocranial dysostosis h. Osteopetrosis i. Thalidomide emryopathy j. Congenital rubeolla 2. Acquired k. Exostosis of the EAC l. Osteom of EAC m. Postsurgical changes n. Recurrent external otitis |
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Increased Bone density of Temporal Bone
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Otic capsule involved
a. Michel deformity b. Labyrinthitis ossificans/obliternas 2. Otic capsule spared c. Paget disease d. Fibrous dysplasia e. OI f. Osteopetrosis |
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Osteolysis of Temporal Bone – DDx
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Focal:
a. Otosclerosis/spongiosis b. EG c. Tertiary symphilis (gumma) d. Osteitis of late congenital syphilis 2. Diffuse: e. OI f. Paget’s disease g. Fibrous dysplasia |
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Petrous Apex Destructive Lesions – DDx
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Infectious /inflammatory:
a. Petrous apicitis/petrous apex abscess b. Malignant otitis externa (skull base osteomyelitis) 2. Benign Tumors c. Cholesteotoma d. Meningioma e. Paraganglioma f. Cholesterol granuloma 3. Malignant Tumors g. Skull base Chondrosarcoma h. Metastasis i. Chordoma j. Lymphoma k. Plasmacytoma/multiple myeloma l. Nasopharyngeal carcinoma |
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Abnormal Soft Tissue Mass in EAC a/w Bony Erosion
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1. Inflammatory:
a. Malignant external otitis b. Benign necrotizign otitis externa c. Cholesteatoma of EAC 2. Neoplastic d. SCC of EAC e. BCC of EAC f. Salivary gland malignancies (adenoid cystic/mucoepidermoid ca) g. Melanoma h. Mets i. Ceruminoma (ceruminous adenoca |
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Soft Tissue in Middle Ear
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1. cholesteatoma
2. Chronic Otitis Media 3. Granulation Tissue 4. Cholesterol Granuloma 5. Malignant otitis externa 6. Glomus tympanicum 7. Neoplasm (SCC in adults, rhabdomyosarcoma in children) |
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Acquired Middle Ear Cholesteatoma –
1. What are the two types? a. Site of TM performation b. Location c. Effect on ossicles d. bone erosion e. ossicles erosion |
Attic cholesteatoma
a. Pars flaccida b. Prussak’s space c. Displace medially d. Laterael tympanic wall e. Malleus and body of incus 2. Sinus Cholesteatoma f. Pars tensa g. Sinus Tympani h. Laterally i. Initially subtle j. Long process of incus |
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Cholesteatoma Complications
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1. Labyrinthine Fistula
2. FN paralysis 3. Sinus Thrombosis 4. Meningitis 5. Encephalitis 6. Abscess 7. Petrous apex syndrome (Gradenigo’s syndrome) |
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CPA MASS – DDX
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1. Mimics/pseudotumors
a. Cerebellar flocullus b. Tuft of choroids plexus c. Proimient AICA d. Prominent jugular bulb 2. Tumors arising primarily in CPA cistern e. Vestibular schwannoma f. Meningioma g. Epidermoid cyst h. Arachnoid cyst i. Nonacoustic schwannoma (trigeminal, facial nerve) |
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CPA MASS – DDX
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Tumors with direct extension from adjacent structures
j. Glomus jugulare k. Brainstem glioma l. Ependymoma of fourth ventricle m. Cerebellar astroctyoma n. Chordoma o. Chondrosarcoma (spheno-occipital synchondrosis) 4. Vascular Lesions p. Vertebrobasilar dolichoectasia q. Aneurysms – vertebrobasilar, AICA r. AVMs 5. Infectious/inflammatory: s. Basilar meningitis (bacterial, fungal, TB cryptococcosis, syphilis) t. Arachnoiditis u. Sarcoid v. Leptomeningeal metastasis |
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Multiple Cranial Nerve and CNS Tumors – DDx
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1. Neurocutaneous Syndromes (phakomatoses)
a. NF1 b. Nf2 c. VHL d. TS 2. Schwannomatosis 3. NF1/NF2 mosaicism 4. multiple meningiomas |
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Vascualr Middle Ear Mass – DDx
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1. Glomus Tympanicum
2. Aberrant Internal Carotid artery 3. Persistent stapedial artery 4. Carotid Artery aneurysm 5. exposed jugular bulb 6. exposed carotid artery 7. hemangioma 8. extensive glomus jugulare |
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Types of Mastoidectomy
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1. Simple (closed canal) Mx
a. Remove some/all mastoid cells b. Maintain EAC/ossicles 2. Radical (open cavity) Mx c. Modified Radical (Bondy) i. Remove mastoid air cells and EAC ii. Ossicular chain intact d. Radical Mastoidectomy i. Remove mastoid cells and EAC ii. Preservation of stapes suprestrucutre iii. Often with tympanoplasty |
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Acute Peripheral FN palsy – DDx
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1. Inflammatory/Infectious
a. Bell’s palsy b. Herpes zoster otticus (Ramsay-Hunt) c. Other viral infections (EBV, HIV, rubella, mumps, polio, coxsackie, influenza) d. Otitis Media/mastoiditis (bacterial, fungal) e. Lyme disease f. Syphilis 2. Trauma g. Temporal bone fracture h. Temporal bone contusion 3. Tumors: benign, malignant, e.g. facial nerve schwannoma ddx 4. Iatrogenic: post-surgical from transmastoid approach 5. Others: (usually more gradual) i. DM j. Hypothyroidism k. Sarcoid l. Guillain-Barre syndrome |
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FN Palsy – DDx
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1. Inflammatory/infectious
a. Bell’s palsy b. Herpes zoster otticus 2. Trauma c. Temporal bone fractures 3. Benign Tumors d. FN tumors (schwannoma, hemangioma, lipoma) e. Acoustic schwannoma f. CPA meningioma g. Epidermoid cyst (congential cholesteatoma) h. Choristoma i. Glomus tympanicum |
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FN Palsy – DDx
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4. Malignant Tumor:
j. Perineural spread (parotid/Eac malignancy) k. Direct invasion i. Glomous jugulare, embryonal rhabdomyosarcoma ii. Langerhan’s cell tumor iii. Cystadenocarcinoma of endolymphatic sac l. Lymphoma m. Mets n. Facial nerve sarcoma |
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Cystic Nasopharyngeal Mass – DDx
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1. Tornwaldt Cyst
2. Encephalomeningocele 3. Phayngeal Cyst 4. Atypical Lymph Node |
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Expansile Nasopharyngeal Mass - DDx
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1. JAF
2. Chordoma 3. rhabdomyosarcoma 4. Schwannoma of 5th Cranial Nerve 5. Nasopharyngeal polyp |
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Solid Mass in Carotid Sheath – DDx
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1. Inflammatory/infectious
a. Lymphadneopathy b. Traumatic neuroma 2. Benign Neoplasm c. Nerve sheath tumor i. Schwannoma ii. Neurofibroma iii. Ganglioneuroma iv. Ganglioblastoma v. Ganglioneuroblastoma d. Paraganglioma i. Glomus vagale ii. Glomus jugulare iii. Carotid body tumor e. Lipoma f. Hemangiolymphangioma g. Granular cell tumor (rhabdomyoblastoma) h. Thyroid/parathyroid tumor 3. Malignant neoplasm i. Metastatic lymphadenopathy j. lymphoma |
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Post-styloid Parapharyngeal (Carotid) Space Mass
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1. Glomus Vagale
2. Glomus jugulare 3. schwannoma 4. meningioma 5. metastasis |
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Nsopharyngeal Mass – DDx
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1. Carcinoma
2. Lymphoma 3. Rhabdomyosarcoma 4. Adenoidal tissue 5. Tornwaldt cyst 6. Retropharygneal adenopathy |
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Fatty Lesions in PPS – DDx
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1. Lipoma
2. Angiolipoma 3. Dermoid cyst/teratoma 4. Hibernoma 5. Lipoblastoma/lipoblastomatosis (peds) 6. Benign symmetric lipomatosis (Madelung disease) 7. Liposarcoma |
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Aggressive nasopharyngeal Mass in a Child
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1. Rhabdomyosarcoma
2. Lymphoma 3. Chloroma 4. Langerhans cell tumor 5. Nasopharyngeal carcinoma 6. Metastatic neuroblastoma 7. Esthesioneuroblastoma 8. Hemangiopericytoma 9. Minor salivary gland malignancy 10. Aggressive infection (fungal, TB, Cocci) |
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Anterior Cystic Neck Mass – DDx
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1. Branchial Cleft Cyst
2. External Laryngocele 3. Thyroglossal duct cyst 4. Necrotic Lymph node 5. Abscess 6. Cystic hygroma 7. Dermoid 8. Thrombosed anterior jugular vein 9. Aneurysm |
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Cystic Neck Mass – DDx
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1. Thyroglossal cyst
2. Branchial cleft cyst 3. Cystic hygroma/lymphangioma 4. necrotic lymph node 5. laryngocele 6. Sebaceous cyst 7. Jugular vein 8. Lipoma |
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Prevertebral Soft Tissue Widening – DDx
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1. Abscess
2. Neoplasm 3. Post-traumatic change 4. Lymph fluid 5. Tortuous Carotid artery |
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Anterolateral Neck Mass – DDx
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1. Pseudomasses
a. Hypertrophy of the sCM b. S/p radical neck dissection 2. Vascular masses c. Asymmetry of jugular veins d. Jugular vein ectasia e. Aneurysm of jugular vein f. Jugular vein thrombosis (bland, septic or metastatic clot) g. Aneurysm of carotid artery h. AV fistula i. Hemangioma j. Lymphangioma |
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Anterolateral Neck Mass – DDx
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Cystic Masses
k. Branchial cleft cyst l. External laryngocele m. Cystic adenopathy n. Thyroid cysts 4. Solid masses o. Adenopathy p. Paraganglioma q. Schwannoma r. Abscess s. Neurofibroma t. Thyroid tumors u. Lipoma |
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Fatty Tumors of the Neck – DDx
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1. Solitary fatty tumor – no contrast enhancement
a. Lipoma b. Dermoid cyst 2. Solitary fatty tumor with contrast enhancement c. Angiolipoma, hibernoma, lipoblastoma/lipblastomatosis, liposarcoma 3. Multiple fatty tumors d. Benign symmetric lipomatosis (Madelung disease) e. Cushing syndrome |
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Diffuse Lipomatosis of Neck – DDx
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1. without inflammatory signs:
a. benign or multiple symmetric lipomatosis b. multiple familial lipomatosis c. morbid obesity d. Cushing diseas/syndrome e. Lipoblastomatosis (children) f. Liposarcoma 2. With inflammatory signs: g. Weber-Christian’s disease (painful adiposities) h. Dercum’s disease (acute panniculitis) i. Progressive nodular lipomatosis |
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Neck Mass with Central Lucency – DDx
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1. BCC
2. Lymphangioma 3. Necrotic Lymph nodes 4. Abscess 5. Benign node with fatty degeneration |
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Ill-defined Enlargemetn of Thyroid Gland with Extrathyroid Extension – DDx
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1. Infectious/inflammatory:
a. Acute suppurative thyroiditis (bacterial or fungal) b. Riedel’s thyroiditis (invasive fibrous thyroiditis) 2. Neoplastic c. Anaplastic thyroid carcinoma d. Thyroid lymphpoma 3. Iatrogenic e. Post-surgical changes f. Postradiation therapy (radiation induced thyroiditis) |
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Multinodular Thyroid Gland Enlargement – DDx
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1. Multinodular goiter
2. Thyroiditis (subacute, Hashimoto’s, Quervain’s, post-partum) 3. Primary or secondary lymphoma 4. metastatic disease 5. Undifferentiated/anaplastic carcinoma 6. Thyroid sarcoma 7. Graves disease |
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Aggressive Looking Thyroid Mass – DDx
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1. Infection: |
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Discrete Mass in the Tracheo-esophageal Groove
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1. Exophytic thyroid nodule
2. Lymphadenopathy 3. Parathyroid adenoma/carcinoma/cyst 4. Nerve sheath tumor (cervical roots/vagus nerve) |
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Primary Tracheal Carcinoma – DDx
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1. Papilloma
2. Granuloma 3. Foreing Body 4. Primary tracheal carcinoma 5. Secondary invasion from adjacent neoplasm 6. Amyloid 7. Ectopic thyroid |
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Epiglottitis, Supraglottitis – DDx
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1. SCC
2. Supraglottitis/epiglottitis 3. Atypical laryngocele 4. Post-traumatic deformity |
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Paralaryngeal Cyst – DDx
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1. Laryngocele
2. Congenital laryngeal cyst 3. Cyst of epiglottis 4. BCC 5. Neoplsm with necrosis simulating cyst 6. Thyroglossal duct cyst |
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Vocal Cord Paralysis – DDx
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1. Old trauma
2. arytenoids dislocation 3. laryngocele 4. Carcinoma |
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Abnormal Shape of the Laryngeal Cartilage – DDx
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1. Abnormal shape of the laryngeal cartilage
2. Chronic posttraumatic deformity 3. Postsurgical changes 4. Acute laryngeal trauma 5. Chondroid neoplasm of the larynx 6. Metastatis to the cartilage 7. Congenital deformity |
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Vallecular Mass – DDx
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1. Cystic
a. Vallecular cyst b. Cyst in base of tongue c. Dermoid/teratoma d. Lymphangioma/cystic hygroma e. Laryngocele 2. Solid f. Ectopic thyroid g. Hemangioma h. SCC |
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Expansile Lesion of Laryngeal Cartilage – DDX
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1. Chondroma
2. Chondrosarcoma 3. Metastasis 4. Post-traumatic deformity |
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Vocal Cord Assymetry – DDx
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1. Glottic carcinoma
2. Recurrent Nerve Paralysis 3. Teflon injection of vocal cord 4. SCC of vocal cord |
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Supraglottic Mass – DDx
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1. Carcinoma
2. Laryngocele 3. Post-traumatic deformity (pseudo-mass) 4. Papilloma 5. Chondroma 6. Metastasis 7. amyloid 8. Hemangioma 9. Lymphoma |
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Pyriform Sinus Mass – DDx
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1. Pyriform sinus carcinoma
2. Post-operative scarring 3. Post-radiation edema 4. Metastases 5. Mesenchymal tumor 6. Lymphoma |
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Destructive Laryngeal Mass centered in the Cartilage – DDx
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1. atypical SCC of larynx
2. Primary chondral tumor 3. Metastasis to larynx (e.g. osteosarcoma) |
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Enlargement of Prevertebral Soft Tissue – DDx
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1. Prevertebral Mass
2. Retropharyngeal Mass a. Adenitis/cellulites b. Abscess c. Edema d. Hematoma e. Lipoma f. Metaststic lymphadenopathy g. Direct invasion from nasopharyngeal or oropharyngeal SCC h. Kawasaki’s disease i. Atypical 3rd BCC j. Hemangioma/lymphangioima |
